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We believe hearing sounds begins in the womb; perhaps learning to recognize a mother’s voice or benefitting from listening to certain types of music. So in all likelihood processing sounds, the beginning of language acquisition begins before birth. A parent may or may not enhance those opportunities. After birth those who have a significant role in a child’s life have a major part to play in language development. Read the rest of this entry →

Proper diagnosis of a language concern is crucial to effective and appropriate treatment. Childhood apraxia of speech (aka developmental apraxia of speech/dyspraxia/verbal apraxia) is frequently both over, and under-diagnosed. Ineffective and inefficient treatment can result.

Introduction:

Childhood apraxia of speech (CAS) is a difficulty coordinating and planning out the production of sounds. It is a disorder of motor planning. The child knows what he or she wants to say, but can’t get his or her mouth to do what the brain wants.

I have long been a believer that no one therapy, and no one therapist can do it “all”. This has become even clearer to me as I have worked with both speech and music therapists in treating children with deficits in social skills.

As occupational therapists we are acutely aware that individuals with various learning disabilities, including autism, are often extremely sensitive to noise and that sensory overload is common. These persons tend to often react to even the most minimal of stimuli as if they were being bombarded with multiple stimuli.

A Day in the Life of an SLP

Christina is a speech-language pathologist. She works with children and adults who have impairments in their speech, voice, or language skills. These impairments can take many forms, as her schedule today shows.

First comes Robbie. He’s a cutie pie in the first grade and has recently been diagnosed with childhood apraxia of speech—or CAS. CAS is a speech disorder marked by choppy speech. Robbie also talks in a monotone, making odd pauses as he tries to form words. Sometimes she can see him struggle. It’s not that the muscles of his tongue, lips, and jaw are weak. The difficulty lies in the brain and how it communicates to the muscles involved in producing speech. The muscles need to move in precise ways for speech to be intelligible. And that’s what she and Robbie are working on.

Next, Christina goes down the hall and meets with Pearl in her third grade classroom. While the other students are reading in small groups, she works with Pearl one on one, using the same storybook. Pearl has a speech disorder, too, but hers is called dysarthria. It causes Pearl’s speech to be slurred, very soft, breathy, and slow. Here, the cause is weak muscles of the tongue, lips, palate, and jaw. So that’s what Christina and Pearl work on—strengthening the muscles used to form sounds, words, and sentences, and improving Pearl’s articulation.

One more student to see—4th grader Mario, who has a stutter. She’s helping Mario learn to slow down his speech and control his breathing as he talks. Christina already sees improvement in his fluency. Read the rest of this entry →

Finding Virtual Learning Technology Answers. Parents and teachers are finding a proliferation of virtual remediation to acceleration brain training programs promising fast and optimum gains in learning reading, math, and science that are research based. It is difficult to believe these promises, as most often the program designers do not have a background in classroom implementation let alone e-Learning implementation, which is totally different form pure classroom teaching.

Many virtual learning entrepreneurs come from backgrounds of scientists and somewhat related fields to education like optometry (testing vision), psychiatry, psychology, and medicine pediatrics (medically treating the whole child, and prescribing stimulant medications). Others are business and technology product development entrepreneurs who have never worked in a classroom, and understand technology delivery parameters, but not how children/adults actually learn and retain information so that it will transfer into real life productivity. Read the rest of this entry →

For parents of children on the Autism spectrum who are in the mainstream classroom environment, the question of having highly qualified professionals on your child's team is an important one. Although most parents want their high-functioning child to be in the mainstream, what they don't realize is that they are giving up the potential of having specialists who really understand their child, in exchange for time in the mainstream with neurotypical peers. The highly qualified clause of the No Child Left Behind (NCLB) act, sadly, does not give parents the right to demand a specialist who is qualified in inclusion, social communication, and other key aspects of your child's learning style. Nor does it require that your child's specialist have a particular passion for incorporating cutting edge technology and strategies to maximize your child's success. When you have specialists on your child's team who don't understand these key components, your child is at risk for social isolation, exclusion, bullying, behavioral challenges and falling below grade level. Read the rest of this entry →

Reading is a fundamental skill needed for academic success. In today’s world, strong literacy skills are essential. Children who struggle in reading tend to experience extreme difficulties in all content areas, as every subject in school requires reading proficiency. When children are then faced with further struggles such as speech production and receptive and expressive language difficulties, the effects can be even more detrimental.

To read proficiently, a child requires highly integrated skills in word decoding and comprehension and draws upon basic language knowledge such as semantics, syntax, and phonology. Children with speech and language impairments, such as Childhood Apraxia of Speech (CAS), have deficits in phonological processing. For these children, phonemic awareness, motor program execution, syntax and morphology will interfere with the ability to acquire the skills necessary to become proficient Read the rest of this entry →

My daughter was an early talker, but through a series of medical issues which included many bouts of otitis media, she completely stopped speaking. This would be a distressing event for any mother, but it was mind altering for me, a Speech-Language Pathologist. I had been a public school Speech Therapist and Resource Specialist, professions in which I tried to rely on evidence-based practices for both oral and written language problems, but it was only after she was born that I began the journey to tie these areas together. At the time so were researchers, therefore I read everything in the exploration for ways to help. Her oral language did come back, but with typical language disorder markers such as problems with irregular past tense verbs, simplistic sentence formation and irregular sequencing. Her abilities to relate what happened at school, explain what I had just read to her (even when shown the pictures), or to tell something she really wanted to explain were all lost in a sea of confusion. To be sure, her articulation was clear and it seemed she had enough words, but her oral language was off kilter, mixed up and difficult to follow. Then, later in school she had enormous difficulty learning to read and write. My journey with her and the many students I worked with agreed with the researchers.

The good news is that today she is a psychologist with a deep understanding of her many clients. The sad news is that even after years of continuous solid research in literacy, my own rewarding private practice utilizing that research, and then reentering the public schools as a Speech-Language Pathology supervisor, I am finding that there is still this crazy separation between oral and written language services. To be sure, it is not the case everywhere, but is typical. In special education, this division is usually fostered by a predictable pattern of a state’s educational code which dictates the type of assessment a particular professional does, then to service delivery, programs and expenditures. Many special education teams do not understand or even collaborate on what all their combined testing results mean, how together they form a picture of a student’s learning profile or how that profile should guide particular remediation strategies or programs.

The usual suspect is a child who is first referred in preschool for speech or language problems, who then follows the typical story of entering kindergarten and having difficulty learning to read. This trouble prompts a second referral to the school study team where a variety of ideas might be tried. For example, some type of after school tutoring might be advised or the student might receive Response to Intervention services. The young learner goes off to be drilled in reading/writing from an instructor or assistant, with most of them having little or no training in language development. Rarely do the Speech-Language Pathologist and instructor/assistant collaborate. Most times the designated service provider never sees the Speech-Language Pathologist, let alone reads the speech report. I have to be honest here and admit that really there is just so much time available, caseloads are highly impacted, and to make matters very complicated, we have a nation of bilingual learners. However, after trying this tutoring approach and finding the child still struggling, further testing usually reveals a learning problem requiring a Resource Specialist. Again, this professional is frequently not trained in language development, has a one-size fits all reading program that may or may not be relevant to each student, and typically does not work closely with the Speech-Language Pathologist. Everyone is really busy with many students, tons of paperwork and numerous meetings.

The US Department of Education Statistics in 2011 showed learning disabilities accounted for half of all documented disabilities, with speech-language disorders a close second. But, the initial, first referred language problem does not just go away. It just changes its name to learning disability. Therefore, the student’s oral speech and language skills can outwardly seem to improve, as did my daughter’s, but the underlying cognitive language deficit remains, spreading its mighty limbs into written language. There many students stay, lodged amongst professionals, none of whom understands their vital reliance on each other, even though oral and written language skills are as intertwined as brain tendrils.

In 1998, a report titled “What Reading Does for the Brain” (Cunningham, A. and Standovich, Keith, American Educator) discussed the relationship between verbal growth and reading. Research has documented a reciprocal connection between reading and oral language. We learn to read, talk about what we learn, write about it and discuss it in class or with family and friends. Reading increases vocabulary knowledge and cognitive skills. The typical classroom is linguistically based and language driven. The artificial delineation of oral and written language in special education hampers the very reason children are qualified for services.

More than 30 years ago, McCarthy wrote: The most important decision you will make is that of definition- because that definition will dictate for you the terminology to be used in your program, the prevalence figure, your selection criteria, the characteristics of your population and the appropriate remediation procedures.

A student’s oral narrative production provides an integrated picture of several language skills at the same time, thus allowing a comparison of words, sentences, and narrative structure (Liles, 1993; Liles, Duffy, Merritt, & Purcell, 1995; Miller, 1981; Miller & Chapman, 1981; Miller, Heilmann, Nockerts, Iglesias, Fabiano, & Francis, 2006). Studies have demonstrated that the oral narratives produced by learning disabled children are likely to be shorter in length (Leadholm & Miller, 1995), use fewer different words (Miller, 1991) have less complex syntax (Gillam & Johnson, 1992), and lack a cohesive structure (Catts, 1993; Catts, Fey Tomblin, & Zhang, 2002). A study in 2007 by Foley, Wasik and Justice on children’s oral narratives and connections to reading comprehension showed that high passage comprehenders as compared to low passage comprehenders scored higher on number of words, number of different words, number of propositions, number of nouns, number of episodic events, and reference cohesion at the sentence level. In a comprehensive assessment, these language skills may be further contrasted with non-verbal cognitive skills, memory, processing, reading and writing scores.

Oral narratives are integral to literacy development and are contained within the continuum of state grade level standards starting as early as preschool. Take, for example, the following excerpt from the CA Language Arts Content Standards in Reading for Kindergarten-

Ask and answer questions about key details in a text.

With prompting and support, retell familiar stories, including key details.

With prompting and support, identify characters, settings, and major events in a story.

In order to ask and answer key questions about a story read in class, a student must have a fundamental knowledge of stories in general. In order to retell a familiar story, whether fictional or a real life experience, a student must be able to sequence events, use a variety of words and be able to tie all of the parts of the story together. Shared assessments among team members and the subsequent program goals within the area of narrative discourse would help eliminate the division among professional assessments, provide a framework for close collaboration and direct therapeutic strategies. The chart below shows the development of literacy as it moves through the grades.

Oral and written narrative ability is embedded in all languages and cultures, uses all of the components of language and is part of every state’s curriculum standards at every grade level, whether for English language learners or English only learners. It has been demonstrated to be crucial for overall reading comprehension. By working together, understanding what all the assessment means and striving for narrative goals, we are achieving collaboration and are focused on developing the student’s language skills within the framework of the content standards. We are devising a likely story of success for every learner.

I have the fun of meeting a LOT of cute kids in my practice as a feeding therapist and likewise, the honor of meeting some great parents. Sometimes the kiddos have Down syndrome or a gastrointestinal tube for liquid tube feedings or autism or for one reason or another are just darn-picky eaters. Know what the common denominator is among all these families, regardless of a child’s diagnosis? STRESS. Parenting a child who does not eat well is STRESSFUL and it’s a very unexpected problem to have in a family. I have never met a new mom who cradled her brand new baby and said, “Gosh, I hope he eats his broccoli.” It never occurs to a new parent that their child will have difficulty eating. Read the rest of this entry →